| NPI | 1104474758 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11003896) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2025015939) |
| 363L00000X Nurse Practitioner (Licence: NM 862238) | |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2026-06-26 |